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About Appeal tribune. (Silverton, Or.) 1999-current | View Entire Issue (July 3, 2019)
SILVERTONAPPEAL.COM ❚ WEDNESDAY, JULY 3, 2019 ❚ 3A OSH Continued from Page 1A is squeezed. The hospital faces a shortage of beds, which hampers its ability to admit pa tients who are facing criminal charges within courtordered deadlines. Meanwhile, employees face the pros pect of overtime and doubleshifts to staff the hospital. That, in turn, can in crease the chances of fatigue and a po tential injury. Hospital officials say that the facility has taken steps to address the problem and eliminated mandatory overtime earlier this year. Now, for example, the facility rotates employees between units to cover highneed areas that have gaps in staffing. For employees, more is needed to fix the systemic challenges of shortstaff ing. But they also know that loosening the purse strings — and the ability to add more staff — is not a simple, quick fix for them or their managers. Ultimately, that power rests with state legislators and Gov. Kate Brown. Rebeka Gipson-King, Hospital Relations Director, unlocks the doors to the cafeteria at Oregon State Hospital in Salem on June 12. MICHAELA ROMÁN/STATESMAN JOURNAL Coping with frequent violence Hospital staff face two sources of vi olence: Patients who are routinely vio lent and patients who are infrequently violent. In the latter cases, employees are "very often hurt worse because they don't see it coming," said Dr. Daniel Smith, a psychologist at the hospital. "Nobody goes to work and says, 'I'm going to get hurt today,'" Smith said. "Nobody goes to work saying, 'I want to restrain somebody today.' However, both things happen." Staff work with patients from a va riety of backgrounds. Most patients en ter the hospital from three broad groups: those found guilty except for in sanity in criminal cases and "aid and assist" patients with pending criminal charges who need to improve so they can aid in the defense of their case. The third main group are patients who arrive through civil commitments, which don't involve criminal charges. The average daily population for the hospital was nearly 600 in 2018. The median patient stay was 89 days, though the length varies depending on each individual patient's circum stances. In 2018, the hospital treated 1,565 pa tients at its main campus in Salem and a satellite campus in Junction City. The two have a combined workforce of about 2,300 employees. The majority of patients have un eventful stays at the hospital. A report on a fiveyear period at the hospital showed 62.3% of patients didn't have a restrictive event, which requires the use of seclusion, restraints or both. But the risks remain real, even if the daytoday odds of an assault are statis tically low. "Unfortunately, injuries are pretty common here," Thoma said. "If you ask staff, especially that have been around for a few years, they're going to have a story about a major injury that they've had." Employees and the hospital admini stration both attribute the rise in inju ries to more highacuity patients com ing in to get treated before returning to court to face criminal charges. Aid and assist admissions rose sharply in the mid2018, said hospital relations direc tor Rebeka GipsonKing. "At roughly 60% of our admissions, these patients are admitted directly from jail and are psychiatrically unsta ble," she said. "It’s in that first 30 days following admission where most behav ioral incidents and restrictive events happen." Thoma works on the maximum secu rity women's unit. She's also vice presi dent of the Service Employees Interna tional Union's bargaining unit for em ployees at the Salem hospital. "I've personally had some major, per manently damaging injuries and it's scary," she said. "It's scary when we get patients that are incredibly assaultive to other patients or to staff and worry about whether or not you're going to (leave) in an ambulance." Thoma said she has PTSD from see ing assaults while working. "One of my coworkers got stabbed in the neck. It was only with a golf pencil, but I shouldn't have to say it was only with a golf pencil." Some injuries to employees don't rise to the level of a worker's compensation claim. "Somebody punches you in the arm and your arm goes numb for a couple minutes, but you never turn it into a SAIF claim," Smith said, referring to Oregon's worker's compensation insur ance program. "It's only when it's a se vere injury." For example, an employee may take a day off if they are hit by a patient and then return to work after taking a per sonal day off. In cases like that, a work er's comp claim isn't filed. Serious employee injuries can run the gamut, though. "Teeth get knocked out, noses do get broken, people do get seriously injured — arms, legs and so on," Smith said. "They go to the ER and they file a SAIF claim and then SAIF approves it and it gets counted." Overtime and staffing The hospital needs the equivalent of 102 fulltime employees in Salem to cov er patient needs beyond what's avail able from existing resources, records show. The calculation includes additional directcare staff needed after factoring in things like planned and unplanned employee absences, training and pa tients that need additional monitoring. GipsonKing said it reflects the number of additional staff needed for optimal conditions across all units for a 24hour period. It also shows why overtime is com mon and the need for more employees. "We could hire over 100 fulltime em ployees and there would still be a need," Thoma said. "The hospital runs on over time. If people didn't sign up for over time, we wouldn't enough people to cov er all of our shifts." Excessive overtime has been a chal lenge for years at the hospital. A 2015 audit by the Secretary of State's office flagged concerns about fatigued work ers. Challenges persist. Employees who spoke to the Statesman Journal said they don't fault management for the staffing shortage. Getting authorization for more permanent positions is up to policymakers. The hospital's management has pushed to bulk up its workforce. The hospital unsuccessfully request ed turning 66 temporary staff positions into permanent fulltime jobs so they can keep more limited duration employ ees who are trained, boosting the qual ity of care and safety. That request was part of the Oregon Health Authority's budget proposal for the 20192021 bien nium. Without a permanent job, temporary staff leave after 17 months. "Ultimately, this results in dimin ished staff and patient safety and pa tient care," the hospital wrote in its bud get request. Gov. Brown didn't include that in her budget request. Instead, the governor's budget has focused on increasing the state's capacity for communitylevel mental care outside the hospital and policy changes to open up avenues for patients better suited for community level care instead of hospitallevel care. "With scarce resources, the state fre quently must make hard choices during the budget process," spokeswoman Lisa Morawski said in an email. The hospital, part of the Oregon Health Authority, has a workforce of hundreds. To put it into perspective, the hospi tal has 1,019 nursing department staff at both campuses, a group that includes nurses, mental health technicians and clerical and management staff. Its pool of limited duration staff has about 175 people. Overtime quickly adds up when fac toring in planned and unplanned staff absences. For example, the hospital can easily have about 80 unplanned staff absences on a given day. That's not including fill ing in for workers with longterm planned absences like medical and fam ily leaves. Overtime problems grew worse when an Oregon Health Authorityordered hiring freeze halted the hiring of new temporary nursing staff in the 20152017 biennium. The hospital said it was forced to re sort to more overtime. That snowballed into bigger problems as limited duration staff exited: mandatory overtime and exhausted employees. It got so bad, in fact, that administra tors were forced to delay firing nursing staff with job performance problems to avoid vacancies. "We also increased risk related to fa tigue of our nursing staff who were will ing to work multiple shifts of overtime," the hospital's request said. "In addition, nursing staff performance issues were not promptly dealt with if a termination was warranted because there was insuf ficient coverage while the position was vacant." The hospital says that's no longer the case. Facing the problems GipsonKing, the hospital spokes woman, said it has not had mandatory overtime since April 5. It's made several changes to reach that point. Directcare staff outside the nursing department can volunteer for overtime to cover for mental health therapists who don't have certified nursing assistant duties. The hospital also has more flexibility in moving staff from one unit to another to cover needs. On June 2, the hospital made a permanent change to move staff across programs and allow them to sign up for voluntary overtime in the Salem campus. That move came after the hospital temporarily tried it to cover anticipated staffing challenges during the holiday season in December and January. "This was very successful in redis tributing the overtime to more than just the people who work on the units with the highest acuity – so successful that we just rolled out the change perma nently on June 2," GipsonKing said. The hospital stressed it takes safety and the welfare of its employees seri ously and conducts staff training on safe interventions to prevent aggression and comprehensive risk assessments. The hospital also does incident de briefs to explore what to do better next time an incident happens. "Just one person getting hurt is not acceptable, and safety for both patients and staff is the top priority for OSH," GipsonKing said. "At OSH, we treat, support and protect patients during the most difficult periods of their lives, pro viding both a therapeutic and safe place to recover. We do everything we can to take care of our staff as well." For staff, long hours can lead to a higher risk of accidents on the job. When staff work a second shift and have a long, 16hour day, Thoma said, "you are more likely to make mistakes." "If you haven't gotten enough sleep or haven't prepared to work a double shift, which is 16 hours, then you're more like ly to make mistakes." Community mental health care The hospital also is facing a pressing need to make structural changes so it can admit "aid and assist" patients, who are required to go there within seven days of a court order. 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